Annals of Surgical Oncology

, Volume 23, Issue 11, pp 3541–3547 | Cite as

Local Control Modality and Outcome for Ewing Sarcoma of the Femur: A Report From the Children’s Oncology Group

  • Najat C. Daw
  • Nadia N. Laack
  • Elizabeth J. McIlvaine
  • Mark Krailo
  • Richard B. Womer
  • Linda Granowetter
  • Holcombe E. Grier
  • Neyssa M. Marina
  • Mark L. Bernstein
  • Mark C. Gebhardt
  • Karen J. Marcus
  • Shailesh M. Advani
  • John H. Healey
  • George D. Letson
  • Richard G. Gorlick
  • R. Lor Randall
Bone and Soft Tissue Sarcomas



The choice of a local control (LC) modality for Ewing sarcoma (EWS) of the femur is controversial. This study aimed to determine the effect of LC modality on tumor LC and patient outcomes.


The study reviewed the treatment and outcomes for 115 patients who had EWS of the femur treated with similar chemotherapy in three cooperative group trials. Patient outcomes were analyzed according to the LC modality using the log-rank test and the cumulative incidence of local or distant failure using competing risks regression.


The median age of the patients was 13 years. The most common tumor location was the proximal femur followed by the mid femur. For 55 patients with available data, the tumor was larger than 8 cm in 29 patients and 8 cm or smaller in 26 patients. For 84 patients (73 %), surgery only was performed, whereas 17 patients (15 %) had surgery plus radiation, and 14 patients (12 %) had radiation only. The 5-year event-free survival (EFS) rate was 65 % (95 % confidence interval [CI], 55–73 %), and the 5-year overall survival (OS) rate was 70 % (95 % CI, 61–78 %). Patient outcomes did not differ significantly according to tumor location within the femur (proximal, mid or distal) or tumor size (<8 vs ≥8 cm). The findings showed no statistically significant differences in EFS, OS, cumulative incidence of local failure, or cumulative incidence of distant failure according to LC modality (surgery, surgery plus radiation, or radiation).


The LC modality did not significantly affect disease outcome for EWS of the femur. Further study of treatment complications and functional outcome may help to define the optimal LC modality.


Overall Survival Local Control Cumulative Incidence Local Failure Ewing Sarcoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by National Institute of Health/National Cancer Institute grant 1K23CA154530 and by U10CA180886 (NCTN Operations Center Grant) and U10CA180899 (NCTN Statistics & Data Center Grant), as well as by U10CA98543 (Chair’s Grant) and U10CA98413 (Statistics & Data Center Grant) grants from the National Cancer Institute. Additional support for research was provided by a grant from the WWWW (QuadW) Foundation, Inc. (

Compliance with ethical standards

Conflict of Interest

There are no conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Najat C. Daw
    • 1
  • Nadia N. Laack
    • 2
  • Elizabeth J. McIlvaine
    • 3
  • Mark Krailo
    • 3
  • Richard B. Womer
    • 4
  • Linda Granowetter
    • 5
  • Holcombe E. Grier
    • 6
  • Neyssa M. Marina
    • 7
  • Mark L. Bernstein
    • 8
  • Mark C. Gebhardt
    • 9
  • Karen J. Marcus
    • 10
  • Shailesh M. Advani
    • 1
  • John H. Healey
    • 11
  • George D. Letson
    • 12
  • Richard G. Gorlick
    • 13
  • R. Lor Randall
    • 14
  1. 1.Division of PediatricsUT MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyMayo ClinicRochesterUSA
  3. 3.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Department of PediatricsUniversity of Pennsylvania Perelman School of Medicine and Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Department of PediatricsNew York University (NYU) School of Medicine and NYU Langone Medical CenterNew YorkUSA
  6. 6.Department of PediatricsChildren’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical SchoolBostonUSA
  7. 7.Department of PediatricsStanford University School of Medicine and Lucile Packard Children’s HospitalPalo AltoUSA
  8. 8.Division of Pediatric Hematology/OncologyIWK Health CenterHalifaxCanada
  9. 9.Department of Orthopedic SurgeryChildren’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical SchoolBostonUSA
  10. 10.Department of Radiation OncologyChildren’s Hospital Boston/Dana-Farber Cancer Institute and Harvard Medical SchoolBostonUSA
  11. 11.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  12. 12.Department of Surgery, All Children’s HospitalH. Lee Moffitt Cancer Center & Research InstituteTampaUSA
  13. 13.Section of Pediatric Hematology/OncologyMontefiore Medical Center–Moses CampusBronxUSA
  14. 14.Department of Orthopaedics, Huntsman Cancer InstituteUniversity of Utah School of MedicineSalt Lake CityUSA

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